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This book describes the medical problems diagnosis, aetiology, prognosis in compensation cases in general or private insurance cases after accidents or in occupational diseases. The first part deals with methods of examination (30 pages), the 2nd part with the consequences of traumatism of the different parts of the eye and visual pathways, including electromagnetic damage (126 pages). In a 3rd part of 80 pages, occupational diseases are described. So far the text is interesting to any ophthalmologist who is asked for a professional opinion, although reference is made to German law exclusively. The last few pages deal with the comparison of different insurance regulations in compensation cases, and this will be interesting to German ophthalmologists exclusively. The text is up to date, printing is excellent.

SOME time ago we gave an analysis of Mr. White's treatise on Contracted Intestinum Rectum. The ingenuity and practical utility of that treatise, we endeavored to impress on our readers. The subject, always of importance, had been brought more under public observation than heretofore, by the publication of Mr. Copeland; the immediate inducement, as it then seemed, to Mr. White's pursuing the inquiry. Since that period many cases have fallen under the care of Mr. White, nine of which are here related.
There are two points in this little volume principally to be looked to : one of these'is a practical fact of some importance ; the other assumes more the character of an hypothesis, though it is not directly hypothetical.
A marked trait in the contracted rectum, and constituting a prominent feature in the diagnosis, is that of the faices being found to be lessened in their diameter. The occasional deviation from this, in advanced stages of the disease, when fasces of a natural size, at times, pass, Mr. White notices, with a view to prevent the practitioner mistaking the cases when this circumstance does arise ; and as it appears mechanically contradictory, he enters into the following explanation of it. " If the stricture should happen to be low in the rectum as not to jtljow room for the accumulation of freces, it must appear evident that 3 f 2 they 404 Critical Analysis. they will be found uniformly small in diameter, in proportion to the degree of stricture, while they continue to be discharged in a figured state.
And also, when the stricture happens to be high up the rectum, so long as the gut below the stricture retains its natural expulsive power, an accumulation will be prevented, and the diminished size of the fasces will continue. But as the disorder increases, the inferior portion of the intestine gradually loses that power; so that when the contraction becomes considerable,, only a small quantity of feces pass at a time through the stricture, and not being sufficient to stimulate the lower part of the rectum, an accumulation goes on from time to time, until at length it becomes difficult to remove; when on these occasions faeces ot a natural size have sometimes been discharged." It has now some time been the fashion, or rather, perhaps, lias now become an admitted fact, that strictures in the urethra, by some, yet unexplained, sympathy, produce morbid actions in distant parts of the system, of a character, a priori, not at all referable to such a cause. Mr. White does not doubt but strictures of the rectum may excite derangement in remote parts of the intestinal canal, or in organs that are associated with it in the performance of its natural functions.
The liver is the organ to which our author looks as most likely to undergo this sympathetic derangement. In two patients a tuberculated state of the liver was believed to be the consequence of stricture in the intestine; and as the opinion is in a measure new, we shall lay before our readers the whole of the third case, which goes, in the author's opinion, particularly to this point. In this the biliary secretion was disturbed, and the alvine evacuations were always of a light clay color, except when the patient was taking calomel. Case 3.?Feb. IS 12, E. Morgan, an unmarried woman, sixtythree years of age, complained of having been subject to pains about the os sacrum shooting down the hips, between four and five years. She had been always of a costive habit of body, seldom having any evacuation for four or five days, and not then without the aid of a strong purgative medicine. About a year ago she was attacked with a sudden hemorrhage, which she supposed to have been a return of the catamenia in a most extraordinary and violent manner; but on the hemorrhage recurring shortly after, she was convinced the discharge proceeded from the rectum ; ever since which she has had frequent returns of the hemorrhage ; and upon that ceasing, a serous discharge supervened. Between five and six months ago she began to experience considerable pain and difficulty in passing her stools, attended with tenesmus, and almost constant pain in the gut: her strength was much reduced, with frequent flushings of heat, but her pulse was regular. " On examination, I found great irregularity and induration in the fectum, aboqt au, inch from the anus, which extended someway up 17th.?Breathing and cough much the same, but now attended with an expectoration free and copious?has had two small loose motions of the same appearance as last. Repr. med. et enema laxativ.
" 18th.?Breathing much the same; a little bloody mucus is brought up with the cough : has had more uneasiness in the bowels. Two injections have been given without producing any effect?-the injection was ordered to be repealed with the addition of a little murias sodm. " 19th.?Had no evacuation until she took some castor-oil this morning, which procured several motions: cough and breathing much the same. "11th.?Complains of having had a considerable soreness in the rectum since the last tent was introduced. Although, on examination with the finger, the contraction does not appear increased, yet there is a greater difficulty in passing the tent from the extreme irregularity on the interna] surface of the gut?the tent was omitted. The bowels were kept open with castor-oil, and the evacuations continued to be discharged without pain or appearance of any blood. Her general health appeared also to be improving, and she was able to sit up a few hours daily, which she had not been able to do for a long time : her appetite was so much better as to render her very desirous of having a little animal food, which was complied with.
" On the 23d a tent was introduced, but could not pass it until I had previously ascertained the direction of the contracted part by introducing the finger, the irregularity of the surface continuing the same. " 25th.?The tent occasioned considerable pain in the rectum, and a little blood followed its removal. She look castor-oil this morning,, not having had a motion since the last tent was introduced.
" 26th.?Had several motions yesterday, and tier bowels very open to-day: does not complain of any particular pain. " 28ih.?A small tent again introduced?the last time. * rt 30th.?Complains of having had much soreness in the rectum since the last tent was introduced, and has had no motion. Rep. enema laxativ. " May 1st.?Passed several motions. Had appeared to be rather weaker, her appetite having failed lor the last day or two; but no. material alteration was observable until the 5th, when, on entering the ward in the morning, I was surprised lo find so great a change in her countenance ; her breathing short; pulse extremely feeble ; with every other appearance ot a speedy dissolution. She died the same afternoon. The nurse informed me she had become suddenly worse in the night. " Appearances on dissection.?On dividing the parietes of the abdomen, there were evident marks of peritoneal inflammation, and the intestines also exhibited a similar appearance, but more particularly the ilium, and its folds were glued together in several places, the consequence of inflammatory exudation; and on its surface there were different patches of coaguiable lymph : there was aiso some purulent matter in the pelvis. On separating the rectum from the sacrum, its posterior part gave way, appearing that only the periioneal coat at this part of the intestine had remained; the other coats having been destroyed by ulceration. The internal surface of the gut was extremely irregular, and its inner membrane entirely destroyed by ulceration; which process had extended somewhat less than an inch from the anus, as fur as the contracted portion of the rectum. The 1 muscular 408 Critical Analysis. muscular coat was very much thickened and indurated, exhibiting the usual cancerous appearance: and in other places (besides the posterior part already noticed) it appeared to be entirely destroyed, as well as the inner coat, by the ulcerative process. At the termination of the ulceration there was a considerable contraction of the gut, from the diseased stale of the muscular coat having formed a complete thick cartilaginous ring; and a little below it the jagged edges of the inner coat projected; its lower portion, as before mentioned, being entirely destroyed by ulceration. Above the cartilaginous ring the intestine was somewhat dilated, its inner membrane having an inflamed appearance, which had extended about two inches up the gut. The muscular and peritoneal coats, at the back part of the superior portion of the rectum, were thickened and indurated, extending in a line along the sacrum for nearly three inches above the contraction; the thickening gradually lessening as it extended upwards. A great quantity of solid fseces was collected above the contracted part, and properly tinged with bile.
ami was every day inspected while any urgent symptoms remained. Afterwards the appearance of blood in the urine was again occasionally observed, though in inconsiderable quantities. This discharge was probably excited by the same cause as a similar one which was noticed in the following case, though originating from different organs." " Mr. Hurt, apothecary and chemist, residing on Deptford Bridge, about a month previous'to the attack, jvhich will be more particularly adverted to, consulted me on the subject of a disease which had been very painful to him for some time, and of which this was the second attack, after a short interval. He described it to be about an inch and an half round the navel. He had been advised to apply leeches, to use fomentations, and to blister the part; from which remedies he thought himself somewhat relieved. Under the circumstances I found him in, I recommended him to keep his bowels well open, and if there should be any material return of the disease, to have blood drawn from the arm to the extent of from sixteen to twenty ounces, which the present state of the habit appeared to me to be capable of allowing. In about a month from this lime I was again desired to see him. He stated, that he had never been well from the complaint lie consulted me about, but that now he was in great torture. He had considerable febrile heat, coated tongue, and a pulse one hundred and ten and upwards, with nausea and vomiting. The local affection was in extent nearly circular, with a diameter of about three inches, making the navel its centre. The sensation of the patient was that of a burning heat, with shooting pains, and a feeling of great weight in the part. The patient had had recourse to leeches, blisters, and fomentations, as before, but with no effect. I recommended blood to be drawn to the extent of sixteen ounces, and the bowels to be kept open. He was afterwards bled five times, to twelve, ten, and eight ounces, as the symptoms appeared to require, without any satisfactory progress being made. In addition, the part was fomented with the decoction of poppies. This was the treatment pursued during the first week of my attendance, and to about the tenth day of the violent return of the disease. It was next determined to try the effects of more active purgatives than had hitherto been done, with the addition of small doses of opium; the latter for the purpose of relieving pain, and repressing the tendency to vomit. By this plan, the bowels appeared to be completely evacuated of their contents, but without any material amendment ensuing. Recourse was then had to considerable doses of opium to relieve the disease, which had certainly the effect of mitigating pain, while the patient was under its powerful influence; but it did not appear to diminish the .disease otherwise. Local bleeding was then employed again, and a blister applied, but ther.e produced no perceptible advantage. The A disease had now continued about three weeks. The local affection was very little abated; the pulse was somewhat diminished in frequency ; and a' fulness and hardness painful to the touch in the part affected, within the limits above described, had become much more evident, and particularly attracted the attention of the patient. Under these circum-3 stances^ Dr. Sutton on Peritonitis. 411 stances, I suggested the use of a common emollient poultice, hut found it increased the local affection considerably. On this report, I determined to recommend the patient to employ a lotion composed of equal parts of aq. ammonia: acet. and water, with half an ounce of rectified spirits to eight ounces. In two days afterwards, I called, and was gratified to find the patient much amended. He stated, that, from the very first application of the lotion, he had experienced relief, and that his pain returned only occasionally, wheu the use of the lotion repressed it. From this time the patient might be considered to be convalescent. The only things afterwards advised, were to keep the bowels open, to be moderate in the use of food, to avoid fermented liquors, and to use the lotion as frequently as might be found necessary. Since which time, (about a year,) I have uniformly heard a good account of Mr. Hurt's health." Several other cases are related, attesting the good effects of cold applications in peritonitis, and in some affections of the chest. One case even proves the advantage of cold seabathing in consumption. We were much gratified with this part of the work, and congratulate the author on his resolution in combating both vulgar and professional prejudice, as well as upon the success which attended his practice.
What will the hot-house practitioners think of applying a cold Jotion to the chest in consumptive cases, which Dr. Sutton very coolly proposes? He has favored us with some interesting particulars of the practice of Dr. Stewart, a clergyman, who has obtained such high reputation in Scotland for curing consumption, as to attract the notice of a noble family in London, who consulted him in consequence of his decided success.
Will it be credited that part of his plan consists in applying cold vinegar and water to the chest daily, which he also recommends to be well rubbed ?
The injurious consequences of wearing too much flannel are illustrated by a case in which the patient consulted Dr. Sutton on account of a cough which had troubled him for some time, and by which he was becoming weak and emaciated.
" After an attendance of about ten days, the symptoms had grown ?worse.
The patient was now so weak that he could with difficulty leave his bed: he had a very harassing cough, with an expectoration of an uncertain character, hectic fever, and profuse perspirations, with a pulse of one hundred and twenty. About this time, in one of my visits, the conversation turned on the stale of the patient's health some years before, which was represented to be delicate, and that he W3s subject to rheumatic affections in various parts of his body, on exposure to cold. On this account, he wore great quantities of flannel, which led me to inquire into the state of his present clothing. I found he was completely invested in flannels of various and the warmest kinds, and that he constantly wore several such garments.
As it appeared (o me that this sort of clothing must be very prejudicial to him in his present state, and particularly by encouraging profuse perspirations, I recommended all but one of these garments to be dismissed, and, as soon as possible, to substitute for the remaining one a coarse calico waistcoat. After this change had been adopted, the patient very rapidly and completely recovered, which was plainly due to the diminished heat on the surface." The remaining portion of the volume is devoted to the consideration of gout; and if personal experience is a recommendation, the doctor's authority is good, for his own sufferings in that complaint induced him to pursue bold and active treatment. In fact his own cure forms the chief part of the essay. He commences with some general observations upon the disease, which tend to dispose the reader to admit that something more may be done both in alleviating the pain, and even curing the disease, than merely leaving the patient to nature and despair. The remarks on this subject are supported by various authorities, and we fully concur with him in opinion that much may be done towards mitigating the violence, and removing the complaint, at least for a time.
The remedies from which he experienced the most decided "benefit were strong purgatives. Fie afterwards, however, was so situated that he could not conveniently take them, and had recourse to a large dose of laudanum, which completely succeeded in subduing his gouty paroxysm.
From some experience, and also having seen the practice adopted by others, we have long been of opinion that opium taken in doses sufficiently large to case the pain and induce sleep, followed up by suitable and adequate purgatives, are strongly to be relied upon in all cases of gout where the practitioner sees no indication to forbid their use. We are, therefore, pleased to find this practice, which at the same time we must remark is no new practice, corvoborated Ljy cients we are indebted for most of the names which at present distinguish cutaneous diseases, and to such authority, till very latelv, we were compelled to resort for their description and treatment. Dr. Willan, the latter end of last century, presented us with the first number of a voluminous Work upon this subject, of which he did not live to complete more than half the intended series. But that half was the most important; the general outline was sketched, though the master-hand was only put to the first part. In this publication he displayed an acquaintance with the writings of the ancients highly creditable to his erudition, and evinced an acuteness of perception, an accuracy of distinguishing, combined with scientific arrangement, worthy of the enlightened physician. From the rude mass of heterogeneous matter before him, he organized a rational system, and enriched it with new observations of his own. The difficulty of the subject is demonstrated by the fact, that eager as wellinformed medical men usually are in the pursuit of objects which may signalize them, the subject of cutaneous diseases had received very little elucidation since the obscure writings pf the Arabians, untjl Dr. Willan happily selected it as deserving his attention, and his success has shewn that his talents were equal to the laborious investigation. It is true that most practitioners were in some degree acquainted with the appearances, and knew something of the mode of treating some of the enjoying the confidence of Dr. Willan, witnessing his practice, and discussing his peculiar opinions and arrangement, has, with a zeal and promptitude which must ensure success, ?0t out the volume before us.
In the preface he cautions us not to consider it as the completion of Dr. Willan's treatise. t( Its sole purpose," he observes, a is to present an abstract of the classification proposed "by that respected author, together with a concise view of all the genera and species which he intended that it should comprehend. The materials for the description of the first four orders have been obtained principally from Dr. Willan's publication, of which the first part of this synopsis may be regarded as an abridgment. Some additional facts, however, have heen supplied from subsequent observation. The remainder of the matter has been derived partly from personal experience and research ; but principally from a constant intercourse with Dr. Willan upon the subject of these diseases, during a period of ten years, while his colleague at the Public Dispensary, and from his own communications In his last illness." Before quoting the definitions, it is right to state that a colored engraving, which for the subject is certainly beautiful, exhibits the eight forms of cutaneous eruptions, and also illustrates some of the genera and species in a very happy manner. DEFINITIONS. " 1. Papula [Pimple), a very small and acuminated elevation of the cuticle, with an inilamed base, very seldom containing a fluid, or suppurating, and commonly terminating in scurf.* < "2. Squama (Scale), a lamina of morbid cuticle, hard, thickened, whitish, and opaque. Scales, when they increase into irregular layers, are denominated crusts. " 3. Exanthema (Rash), superficial red patches variously figured, and diffused irregularly over the body, leaving interstices of a natural color, and terminating in cuticular exfoliations. a. Phlyzacium, a pustule commonly of a large size, raised on a hard circular base, of a vivid red color, and succeeded by a thick, hard, dark-colored scab.* " b. Psydracium, a small pustule, often irregularly circumscribed, producing but a slight elevation of the cuticle, and terminating in a laminated scab. + Many of the psydracia usually appear together, and become confluent; and, after the discharge of pus, they pour out a thin watery humor, which frequently forms an irregular incrustation. " c. Achor, and " d. Favus. These two pustules are considered by the majority of writers from the Greeks downwards, as varieties of the same genus, differing chiefly in magnitude.} The achor may be defined a small acuminated pustule, containing a straw-colored matter, which has the appearance and nearly the consistence of strained honey, and succeeded by a thin brown or yellowish scab. The favus, or is larger than the achor, flatter, and not acuminated, and contains a more viscid matter; its base, which is often irregular, is slightly inflamed; and it is succeeded by a yellovv, semi-transparent, and sometimes cellular scab, like a honey-comb, whence it has obtained its name. " 6, Vesicula (Vesicle), a small orbicular elevation of the cuticle, containing lymph, which is sometimes clear and colorless, but often opaque, and whitish or pearl-colored. It is succeeded either by scurf, or by a laminated scab. " * The derivation of this term, ' <P*v&, sive tpXvo-av, quod fervere significat, et ebullirc,' (Gorrasi Def". Med.) would render it sufficiently appropriate to elevated and inflamed pustules, it we had not possessed also the interpretation left by Celsus: e auteni paulo durior pustula est, subalbida, acuta; ex qua quod expiimitur, humidum est. Ex pustulis vero nonnuhquam etiam ulcuscula fiunt, aut aridiora, aut humidiora: et modo tantum cum prurigine, modo ctiam cum inflammatione aut dolore; exitque aut pus, aut sanies, aut utrumque. Maximeque id evenit in aetate puerili; raro in medio corpore; saepe in eminentibus partibus.' (De Medicina, lib. v? cap. 28, ? 15.)" v" f As the Phlyzacia were denominated from the heat of the eruption, so the Psydracia received their appellation from the opposite quality, '  JLoc. Affect, lib. iv. cap. 12." " 7. Tv-"7. Tuberculum (Tubercle), a small, hard, superficial tumor* circumscribed, and permanent, or suppurating partially. "8. Macula (Spot),,& permanent discoloration of some portion of the skin, often with a change of its texture. " The following terms are used in their ordinary acceptation, viz. " 9. Wheal, a rounded or longitudinal elevation of the cuticle, with a white summit, but not permanent, nor containing a fluid, nor tending to suppuration. " 10. Furfur (Scurf), small exfoliations of the cuticle, which occur after slight inflammatioaof the skin, a new cuticle being formed underneath during the exfoliation. " 1J. Scab, a hard substance covering superficial ulcerations, and formed by a concretion of the fluid discharged from them. " 12. Stigma, a minute red speck in the skin, without any elevation of the cuticle. When stigmata coalesce, and assume a darkred or livid color, they are termed Petechia." As many of our readers may not be acquainted with Dr. Willan's arrangement, we shall lay it before them, and then subjoin a specimen of Dr. Bateman's valuable performance, which ought to be in every one's hands. " The diseases of the skin were arranged by Dr. Willan in eight orders, according to their external forms above defined, as in the following Where every part of a work is excellent, we are spared the necessity of criticism, and can have no hesitation about selecting specimens, for there is no occasion for choice. We cannot abridge, for Dr. Bateman has condensed his information as much as possible: it only remains for us, then, to recommend the work in the most unqualified manner. At the same time we must not be supposed to insinuate that the work is perfect, for we have no doubt that the learned author will very shortly acquire still more extensive practical knowledge upon the subject; but we consider it the onlv book extant that contains a comprehensive yet explicit account and scientific arrangement of the diseases of the skin; keeping always in mind that Dr. Willan's great work was only half completed. We think Dr. Bateman might have said more upon Lupus, for in proportion as the disease is rare, and of difficult cure, he should have exerted himself to collect more particulars than he has accomplished. His alleged i-eason appears to us merely a ruse to avoid delay in getting out his book: he hastily observes, " Of this disease (Lupus) I shall not treat at any length, fori can mention no medicine which has been of any essential service in the cure of it; and it requires the constant assistance of the surgeon, in consequence of the spreading ulcerations in which the original tubercles terminate." We have seen a very severe case of this formidable disease, which had extended over nearly half the body, and was gradually advancing, completely checked, and finally desti'oyed, by the application ot caustic. We have no doubt Dr. Bateman will have more to say upon this disease on a future occasion, and that he will not slur over the diseases resembling syphilitic appearances, although not always connected with venereal poison, as his laudable haste in furnishing the public with the present volume has probably induced him to do on this occasion. Non omnia possumus orrvnes, and Dr. B. has atchieved more in a given time than his warmest friends could have expected. He will therefore, after the-manner in which we have stated the impression his book made upon us, no doubt pardon thes.e hints, wo, 177.
3 H Some 418 Critical Analysis. Some readers will not purchase without a sample, and, as we before observed, the work will not admit of any curtailment, we shall copy the author's account of Lepra, the first genus of the second order Squama. " The' term Lepra is here appropriated solely to the leprosy of the Greeks, as described by the more accurate of those writers. It is characterised by ' scaly patches, of different sizes, but having always nearly a circular form.*' " 1. Lepra vulgaris, the ordinary species of the disease in this country, commences with small, round, reddish, and shining elevations of the skin, at first smooth, but within a day or two exhibiting thin while scales on their tops. These gradually, sometimes rapidly, dilate to the size of half-a-crown, still retaining their oval or circular form, and are covered with shining scales, and encircled by a dry, red, and slightly elevated border. In some cases these scales accumulate so as to form thick prominent crusts. If the scales or crusts are removed, the skin appears red and shining, being very smooth, and free from the cuticular lines in the beginning, but marked, in the advanced stages, with long deep lines and reticulations, not always coinciding with those of the adjoining surface. " The lepra most commonly commences on the extremities, where the bones lie nearest to the surface, especially below the elbow and the knee, and usually on both arms, or both legs, at the same time. From these points it gradually extends, by the formation of new and distinct patches, along the arms or thighs, to the breast and shoulders, Dr. Bate man's Synopsis of Cutaneous Diseases. 419 and to Ihe loins and sides of the abdomen. In several cases I have observed the eruption most copious and most permanent round the whole lower belly. The hands also become affected, and in many cases the hairy scalp; but the face is seldom the seat of large patches, although some scaliness occasionally appears about the outer angles of the eyes, and on the forehead and temples, extending from the roots of the hair. In the more severe cases, the nails of the fingers and toes are often much thickened, and become opaque and of a dirty yellowish hue, and are incurvated at the extremities: their surface is also irregular, from deep longitudinal furrows, or elevated ridges.
" When the eruption of lepra is moderate in degree and extent, it is not attended with any uneasy sensations, except a slight degree,of itching when the patient is heated by exercise, or becomes warm in bed; and a little occasional tingling in certain states of the atmosphere.* When it is generally diffused, however, and there is a considerable degree of inflammation in the skin, it is accompanied with extreme soreness, pain, and stiffness, which I have sometimes seen so great as to render the motions of the joints impracticable, and to confine the patient to bed. Yet even under these circumstances there is no constitutional disturbance; and if no medicine be era^ ployed, the disease of the skin may continue for months, or even years, without any material derangement of the system. " It is not easy to point out the causes of this disease, which appear, indeed, to be very various; for it is one of the most common affectionsof the skin, at least in this metropolis, and occurs at all periods, and under every circumstance of life.f ' It is certainly not communicable by contagion, nor does it appear to originate from confinement to certain kinds of diet, such as fish, dried or salted meats, &c.
since it is not endemic in districts where these are habitually used, and occurs frequently where they are almost unknown. But, like some other cutaneous affections of a more transient character, it is certainly produced occasionally by the influence of particular articles of food and drink, which operate through the idiosyncrasy of individuals. I have met with one gentleman in whom spices or alcohol speedily produce it. The original attack in him occurred after eating \ " Hippocrates remarks that some Lepra; itch before rain : lib. rhp Xy/xwv." " f It is difficult, therefore, to account for the opinion expressed by the late Dr. Heberden, respecting the extreme rarity of lepra in this country. ' De vero scorbuto et lepra, nihil habeo quod dicam, cum alter rarissimus est in urbibus, altera in Anglia pene ignota ; unde factum est ut hos morbos nunquam curaverim.' (Comment, cap. 2.'}.) And still more difficult to explain the statement of Dr. Cullen, whose definition of lepra will include both the dry and humid tetters (Psoriasis and Impetigo) with the proper scaly lepra ; but who nevertheless affirms that he had never seen the disease. Nosol. Meth, class iii. gen. 88, note." 3 h 3 420 Critical Analysis. some hot soup, containing spice, the first spoonful of which excited 3 violent tingling over the whole head, which was followed by the leprous eruption, which soon extended to the limbs. In another case, in a young gentleman of nineteen, the disease commenced after taking copious draughts of cream; and vinegar, oatmeal, and other species of food, to which it has been ascribed, have probably given rise to it occasionally: but these are all anomalies, and are only referable to peculiar idiosyncracy.* In some cases it has commenced after violent and continued exercise, by which the body had been much heated and fatigued. " Dr. Willan has imputed the origin of lepra to cold and moisture, and to certain dry sordes on the skin. It has seldom occurred to me, however, to witness the disease in bakers, laboratory men, and others who work among dry powdery substances; while I have observed a considerable number of cases in young ladies, and in persons of both sexes in respectable ranks of life, by whom every attention to cleanliness was scrupulously paid. Where cold and moisture have excited the eruption of lepra, the predisposition to it must have been peculiarly great. On the whole, the causes of this disease are involved in much obscurity. There is obviously an hereditary predisposition to it in some individuals. " 2. Lepra alphoidesf. This is a less severe form of the disease than " * Some poisonous substances taken into the stomach have produced an eruption of lepra. The poison of copper is slated to have speedily excited it in several persons at the same time, in one of whom it continued for a month, but disappeared in the others in about ten day$. See Med. Facts and Obs. vol. iii. p. 61."